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Cost Effectiveness of Genotype-Guided Warfarin Dosing in Patients with Mechanical Heart Valve Replacement Under the Fee-for-Service System

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Abstract

Background

Although studies assessing the cost effectiveness of genotype-guided warfarin dosing for the management of atrial fibrillation, deep vein thrombosis, and pulmonary embolism have been reported, no publications have addressed genotype-guided warfarin therapy in mechanical heart valve replacement (MHVR) patients or genotype-guided warfarin therapy under the fee-for-service (FFS) insurance system.

Objective

The aim of this study was to evaluate the cost effectiveness of genotype-guided warfarin dosing in patients with MHVR under the FFS system from the Korea healthcare sector perspective.

Methods

A decision-analytic Markov model was developed to evaluate the cost effectiveness of genotype-guided warfarin dosing compared with standard dosing. Estimates of clinical adverse event rates and health state utilities were derived from the published literature. The outcome measure was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were performed to explore the range of plausible results.

Results

In a base-case analysis, genotype-guided warfarin dosing was associated with marginally higher QALYs than standard warfarin dosing (6.088 vs. 6.083, respectively), at a slightly higher cost (US$6.8) (year 2016 values). The ICER was US$1356.2 per QALY gained. In probabilistic sensitivity analysis, there was an 82.7% probability that genotype-guided dosing was dominant compared with standard dosing, and a 99.8% probability that it was cost effective at a willingness-to-pay threshold of US$50,000 per QALY gained.

Conclusion

Compared with only standard warfarin therapy, genotype-guided warfarin dosing was cost effective in MHVR patients under the FFS insurance system.

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Author contributions

Ho-Sook Kim and Jae-Gook Shin conceived and designed the study. Dong-Jin Kim and Ho-Sook Kim collected and assembled the data. Dong-Jin Kim, Minkyung Oh, Eun-Young Kim, and Ho-Sook Kim contributed to the data analysis and interpretation of data. Dong-Jin Kim and Ho-Sook Kim drafted the manuscript. All of the authors had roles in conception and design of the study; collection and assembly of data; data analysis and interpretation; and preparation, review, and approval of the manuscript.

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Authors and Affiliations

  1. Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, 633-165 Gaegum 2-dong, Busan Jin-gu, Busan, Republic of Korea

    Dong-Jin Kim, Ho-Sook Kim, Minkyung Oh, Eun-Young Kim & Jae-Gook Shin

  2. Department of Clinical Pharmacology, Inje University Busan Paik Hospital, 633-165 Gaegum 2-dong, Busan Jin-gu, Busan, Republic of Korea

    Ho-Sook Kim, Eun-Young Kim & Jae-Gook Shin

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  1. Dong-Jin Kim
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Correspondence to Ho-Sook Kim or Jae-Gook Shin.

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Funding

This study was supported by a grant from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI15C1537).

Conflict of interest

Dong-Jin Kim, Ho-Sook Kim, Minkyung Oh, Eun-Young Kim, and Jae-Gook Shin have no conflicts of interest.

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Formal consent is not required for this type of study.

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Kim, DJ., Kim, HS., Oh, M. et al. Cost Effectiveness of Genotype-Guided Warfarin Dosing in Patients with Mechanical Heart Valve Replacement Under the Fee-for-Service System. Appl Health Econ Health Policy 15, 657–667 (2017). https://doi.org/10.1007/s40258-017-0317-y

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